'Theoretical Issues in Stuttering', by Packman and Attanasio

Book review by Robin Lickley, Research fellow, Queen Margaret University College, Edinburgh.

There are many theories of stuttering, and not one predominates. It's difficult to decide rationally which theory is better and why. People tend to have their preferences, based on their own intuitions and experience. Often, the reasoning behind such a choice is hard to explain to others. Aimed at SLTs, lecturers, advanced students and researchers, this book attempts to address this problem by presenting guidelines on how to assess the merit of any theory of stuttering.

The twelve chapters are spread over what are basically five major sections:

1. Chapters 1-3 present a long discussion of scientific reasoning and theory and how to evaluate theories (chapters 1-3). Four main criteria for evaluating theories are listed: Testability and falsifiability; Explanatory power; Parsimony; Heuristic value - all useful stuff for interested readers, and the sort of thing that ought to be included in any first year university course.

2. A chapter on how theories of stuttering have followed fashions in psychology and the physical and social sciences.

3. A chapter addressing the 'Explanatory Power' criterion, mentioned above, with declaration of 5 things that any theory of the cause of stuttering should explain:
i. Why people repeat, block and produce other 'superfluous' behaviours;
ii. The onset and development of stuttering;
iii. Natural/spontaneous recovery;
iv. Genetics;
v. Why stuttering varies both between and within individuals.

4. In the next five chapters, the authors apply the criteria that they've laid out to a selection of causal theories, models or hypotheses from the past 15-20 years. The 10 theories are slotted into five categories: speech motor control; systems control modelling; cognitive and linguistic processing; multifactorial models; anticipatory struggle.

5. Discussion and comments.

The authors conclude with some thoughts on the interface between theory and practice, asking how often therapy is based on theory, whether effective therapy can be seen as confirmation of theory (despite the logical fallacy of affirming the consequent), whether there's any evidence behind therapy.

Without wishing to belittle the role of clinical skills, the authors remind us that the SLT has a responsibility to use effective and efficient treatments which are based on evidence. They see hopeful signs for evidence-based practice in the recent work on a randomised controlled trial (for the Lidcombe Programme).

They use the Lidcombe Programme as an example of therapy which they suggest has evidence of being effective despite having no causal theory behind it.

Finally - can successful therapy lead to theory? The authors give Packman's own theory as an example of how this may occur.

It must be hard to write any book from an atheoretical perspective, even if you consider your preferred preschool therapy programme to be atheoretical. It is also hard to read a book as if it is theory-neutral, when one knows the allegiance of the authors - it is often too tempting to say 'well, they would say that, wouldn't they' (so I'm trying not to). Knowing the views of another member of the Australian Stuttering Research Centre (ASRC), I was expecting a good few criticisms of multifactorial models and I certainly wasn't disappointed. I was also intrigued to find out whether there was a strong theoretical basis to the work of the ASRC, but here I was disappointed. But the point of the book is to present a framework for discussing theory and not to present a theory.

In such a broad-ranging book, it is relatively easy to pick on areas to criticise, but I have a word limit, so I won't even start. Remaining neutral, I can say that one unfortunate feature of any text book is that it is frozen in time: Anyone wanting to see an assessment of any theory/model/hypothesis initiated in the 21st century or based on recent brain imaging work will have to attempt to employ the guidelines themselves.

In summary, the book gives a reasonable background to scientific thinking for SLTs and others interested in theories of stuttering and gives some useful pointers to some of the influential and not so influential theories from the past two decades. It raises issues that need to be considered in the vast and messy fields of research and therapy for stuttering.